Poor medical aid cover for pro SA cyclists?

[widget]

Hmm, I am sure the issue here refers to Mr Cox, I assume from the posts he was in a State hospital?

 

That said, state hospitals here are really very good, the level of care is excellant, perhaps there are no pretty pictures on the wall and Tvs are in short supply, but the medical care is of the best around, my brother is a doctor and helps out on occassion at some state facilities, so in some cases the very same doctor who would assist you in a private facility is the same one assisting you in a state facility.

 

I am almost sure a private hospital could not have done more for Mr Cox, but I agree, a medical aid is vital in this country, mainly for speedy hospital admissions and treatment, which in many cases can be critical.

 

[Tumbleweed]

word of caution to the lot of you.

 

had medical aid, my employer insisted on it. there i am minding my own business when a taxi decides to cut me off. i fly into to the backof it at about 30km/h. cut a long story short, because i have med aid, get taken to a nice private hospital. lost 13 teeth, smashed my jaw to pieces, broke my nose, etc, etc.

 

discharged the next day cos my facial bones are too unstable to be operated on. come back in four days. med aid says "here are your authorisation codes for the hospital stay, the maxillo sugeon anaethetist". three months later, letter from the med aid: "it has come to our attention that your injuries were sustained as a result of a vehicle accident. bonitas (bastids) is not responsible for any costs resulting from third party."

 

get on the phone. ask if i hit a tree and did the same injuries, would you pay for it? of course, i'm told.

 

so far, paid R25000 out of my own (not-so-deep) pocket for my treatment. just got quote this morning for first set of reconstructive surgery - R12655.

 

point i'm making that you can be covered, but read the fine print. maybe the occupation, cycling, makes it prohibitively expensive for pro cyclists, who earn decently, but are not rolling in it. i'm a journalist, but my premiums are higher because of my occupation despite my protests that i'm office-bound.

 

med aids, like insurance companies, are out to screw you!

[FanieFiets]

widget - Ek verwys glad nie na Mr. Cox nie. Ek weet staatshospitale is nie so sleg soos almal maak dit is nie, behalwe ICU and vinnige submission waar dit die veskil kan maak. Natuurlik is cosmetic surgeons ook nie daar nie.......jy kan dalk disfigured wees vir die res van jou lewe, maar jy sal leef.

 

holy roller - Dit klink vir my nie reg nie......groot fout. Hulle kan weier as dit volgens hulle kosmeties is maar 3rde party klink na 'n funny een. Ek het gou uitgevind, volgens die mediese persoon by ons werk kan hulle dit nie uitsluit nie aangesien dit 'n ongeluk is wat deur die staat as 'n PMB (prescribed minimum benefit) tel. Dus MAG hulle dit nie uitstluit nie. Jou stappe is as volg. Vat dit verder met hulle. As jy nie reg kom nie, vra om na hulle ex-gratia afdeling verwys te word as dit nie werk nie dreig hulle met die ombudsman, as dit nie werk nie, gaan na die ombudsman. 

[Tumbleweed]

faniefiets, thanks.

the only advice i've received is from a lawyer who is only interested in making money out of the RAF. didn't advise me on my rights with the med aid. shot, dude!

[FanieFiets]

no problem.....onthou om alles op skrif te doen. 

[Old Dog]

The situation with pro teams such as TBL is that they provide medical cover for all activities where the rider is working on behalf of the team - racing, training, etc. If the rider was on vacation and has a cycling accident then it is at his own cost as is illness's such as flu, colds, dental, etc,etc. So most cyclists would have their own personal "hospital plan" where there isn't a national health system.

Typically when James Perry was knocked off his bike in Pietermaritzburg whilst warming up for the Ama he had to pay the account himself for a broken femur although in Barlows kit. Lucky for him he had an insurance which covered the R40k costs!!!

So it's a bit of both depending on the circumstances and of course, whats affordable.

[softboy]

sorry to wee-wee on the batteries on those who pay their bonds with insurance commission, but it appears that the medical insurance game is about as full of holes, loop holes and room for impoverising our hard paying taxed nation as mugabe's constitution.

paying only when in a race and riding with TBW kit. sorry, but with a definition such as this, i wonder what the insurance deal was? Sounds cheap. after all, insurance companies are jusy two fractions better on the gray scale of doubtful business better than banks.   

[FanieFiets]

 

 

sorry to wee-wee on the batteries on those who pay their bonds with insurance commission' date=' but it appears that the medical insurance game is about as full of holes, loop holes and room for impoverising our hard paying taxed nation as mugabe's constitution.

paying only when in a race and riding with TBW kit. sorry, but with a definition such as this, i wonder what the insurance deal was? Sounds cheap. after all, insurance companies are jusy two fractions better on the gray scale of doubtful business better than banks.   

[/quote']

 

Softboy - Ek het niks met die bemarking van mediese fondse te doen nie, maar werk in die bedryf en wil net die volgende vir jou uitwys. Die kommissie op mediese fondse is 3% met 'n maksimum van R 50-00 per maand. Meeste makelaars/finansiele adviseurs vermy die besigheid omdat daar teen 'n verlies gewerk word. Probleem is dat jy juis 'n persoon met kennis nodig het om jou daarmee te help om JUIS die loopholes te vermy.  Die betaal van in kit en uit kit het NIE met die mediese mpy te doen nie maar barloworld se beleid teenoor hulle ryers.

 

watter alternatief stel jy voor teenoor om aan een van die obvious evil mediese fondse te behoort?

FanieFiets2007-08-01 23:23:25

[slowpoke]

for all the naysayers, i hardly paid a thing for 2 days in St Augustine's hospital in Durbs, 1 day in Wilgeheuwel, a whole lot of physio, another day in Wilgeheuwel and some more physio following my amashova crash. i paid NOTHING for the car crash in April - the only requirement is if/when i claim from MVA I pay back everything that med aid has paid first and only then does any of that payment go to me - makes reasonable logical and ethical sense in my opinion. back in 2004 i think my total share worked out to less than R200 for 4 days in wilgeheuwel, 2x x-rays, 1x MRI and masses of physio.

 

med aid is well worth it as a sports person and as a road user.

[pastapouch]

 

med aids' date=' like insurance companies, are out to screw you!

[/quote']

ever wondered why they all live in glass houses and we in the crap we do??

[widget]

Yes, medical aids are in essence "insurance" and have various clauses and limitations, usually to the insurers advantage.

 

As most folk dont read the small print but just sign on the dotted line and feel protected, it can come as a shock when making a claim, to find that you are in fact not covered!.

 

As in any contract, get explanations on the exclusions, if necessary go so far as to have an attorney / specialist read over it and advise.

 

It sounds like overkill now, but on the day you need to claim, you will be overjoyed you did.  

[Marius]

I'm with Discovery, die Coastal Plan, think it's the cheapest they had, is it any good or is there something for cheaper just as good of better??

[mountain_lion]

 

 

 

 

In addition to being a cyclist, I am a mountaineer.

 

Every now and again the battle with the medial aids flare up again.

A year or 2 ago Discovery wanted to exclude all mountaineering from cover (might even have been all "high risk sport").

Then they tried excluding "climbing with ropes" - to which I asked them if they would cover me if I then rather climb without ropes....

As soon as you do something that is out of the norm, the insurance industry hears alarm bells. Does not matter that driving to the venue of your chosen activity is actually much more dangerous with a much higher risk of resulting in a claim.

 

I am not sure where we stand at present as far as mountaineering is concerned. AFAIK we are OK on SA soil (at least with Discovery - I am on their Coastal plan).

However every time I intend to leave the country, I try to get written confirmation of the cover offered for the activity I intend to be involved in. If the acivity includes anything "out of the norm", this normally takes several months and various letters with varied outcome.

 

All insurance companies, medial aids included, are out to screw their clients where ever possible!

 

 

mountain_lion2007-08-02 03:46:06

[FanieFiets]

 

I'm with Discovery' date=' die Coastal Plan, think it's the cheapest they had, is it any good or is there something for cheaper just as good of better??[/quote']

 

net KeyCare by Disc is cheaper, maar nie baie nie en die dekking is swakker. Coastal core se uitbetalingvlak is egter hierdie jaar afwaarts aangepas so ek het GAP cover uitneem om veilig te wees. GAP cover betaal die verskil tussen wat die mediese fonds betaal en wat die dokter charge, kos so R 65 vir 'n gesin.

 

[pastapouch]

I don't know whether there would be someone doing this , does anybody know a broker who handles all the medical aids concerning membership and info?

[FanieFiets]

 

I can refer you to one who does a fair amount of funds. No one will do every fund there are too many. But she will charge you an hourly rate if you want in depth comparisons. So dit kan donners duur raak.

 

FanieFiets2007-08-03 04:35:53